Long-term care insurance (LTCI) in Germany

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1 Long-term care insurance (LTCI) in Germany Presentation at the Conference Managing Innovation and Reform in Healthcare, University of Minnesota, November 13th, Minneapolis Dr. Martin Schölkopf Federal Ministry of Health, Germany

2 Specific contribution rates to Social Security 19.6 % 15.5 % 3.0 % 1.95 % Pension Insurance Health Insurance Unemployment Insurance Long-term care Insurance Occup. Accident Insurance Introduced:

3 How is LTCI financed? Pay-as-you-go system Full revenue equalization scheme between all LTC-funds Social security contributions in LTCI Contribution rate: 1.95 % of gross income, maximum Euro/month Employers pay half the rate (0.975 %) Childless employees pay supplement of 0,25 % Unemployed spouses and children: free insurance 3

4 Social and private mandatory LTCI LTCI is an independent branch of the social protection framework in Germany. Entire population is insured: 69,48 mio. in the social LTC insurances. 9,50 mio. in private mandatory LTC insurances. The social LTCI is implemented by the long-term care funds (145) which, in organisational terms, are attached to the social health insurance funds ( LTCI follows health care insurance ) private health insurance companies (about 45): responsible for the private mandatory LTC insurance are 4

5 Private mandatory long-term care insurance - principle features - o membership follows regulations on private health insurance plans o capital covered system with regard to premiums o premiums may not exceed maximum contribution of social LTC insurance o calculations are based exclusively on age of entry, not according to pre-existing conditions o application, entitlement and benefits as in social LTC insurance o compulsory risk adjustment scheme between insurance companies 5

6 In Brief: Definition, Eligibility, Assessment Procedure Persons in need = physical, psychological, mental handicap which requires help to carry out daily and recurring routines of day-to-day life over a period of at least 6 months. Relevant areas of needs = personal care including hygiene, nutrition, mobility, housekeeping. 3 levels of care Assessment by medical service of the funds to identify the care needed. 6

7 Provision of services by LTCI Long-term care insurance funds have to ensure provision of benefits For this purpose, funds have to negotiate contracts concerning quality and remuneration of home care services and nursing homes Benefits offered differ according to need and place of care Option to chose between benefits in cash or in kind Mix of services possible, as well as day care and care Benefits cover only part of the costs Since 2008: Stepwise increase of benefits (up to 2015); adjustments of benefits on a regular basis (from 2015 on) 7

8 Benefits in cash, home care 8

9 Benefits in kind, home care 9

10 Benefits for institutional care 10

11 Statistical key data on LTC (2009) 2.34 mio. beneficiaries 1.62 mio (69%) dependent persons cared for at their homes by the use of (31%) dependent persons cared for in inpatient facilities only relatives: 1,07 m dependent persons home care agencies: dependent persons - broken down into care levels % - broken down into care levels % 33.9% 28.4% 14.7% 7.7% I II III I II III 36.8% - broken down into care levels % 20.5% I II III 1.5% previously unrelated Source: German Federal Statistical Office (Statistisches Bundesamt) home care agencies with employees inpatient facilities with employees 11

12 Expenditure 1,1 per cent of GDP Finances of Social LTCI in 2011 revenues of 22,1 bn benefit expenditure of 20,9 bn administrative expenditure of 1 bn ratio cash allowance/benefit in-kind expenditure 61 : 39 recipients 79 : 21 12

13 Results after 15 years of Long-term care (LTC) in Germany: Strengthening of care at home due to LTCI LTCI is highly accepted more than 2 mio. people in need of care get benefits out of LTCI every month need of additional social assistance grants declined infrastructure of LTC-facilities clearly enhanced more than additional jobs since

14 Challenges ahead... demographic trends and increasing lifeexpectancy, ageing society financial sustainability, encouraging additional private insurance Adequat benefits according to needs, in particular for persons with dementia adequate community-based supply of LTC services 14

15 Growing Pressure on the Contract between Generations

16 16

17 Risk of requiring long-term care: before reaching the age of 60 years: approx. 0.8 % between 60 and 80 years of age: approx. 4.6% above the age of 80: approx. 29.7% number of persons requiring long-term care: m 2.82 m 3.28 m 3.73 m 4.37 m 17

18 Reform of the LTC-Insurance in 2012 Aims: Improving and enhancing benefits for people with dementia (as a first step) Make benefits more flexible Improving rehabilitation Help caring relatives Encourage voluntary privat LTC insurance (supplementary) Increase of contribution rate of 0,1 percentage point 18

19 Thank you for your attention! 19

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